HomeMy WebLinkAboutWYNTER PARK #1 BLK 1 LT 48
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 9950'1 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTIC)N REPORT '
PHONE ~--~
NAME
LOCATION
Well ~ Absorption area
Lq.,
~ O O IF HOMEMADE:
DISTANCE TO: We~ Dwelling
DISTANCE TO:
No, of lines ~
Len 9t~o~ea~h line
Top of tile t~ finish grade
Width
Crib diameter
Wei~
Foun~atio~ ~' /
Total len g~h ~.~.Ji nos
Material beneath tile
Depth
Crib depth
Building foundation
Lwl(Ith --(/ -
__ [Material
Trencb width
inches
NO, OF BEDROOMS
L~quid depth
Distance between lines
PERMIT NO.
Depth Driller PERMIT NO,
Buildin9 foundation Sewer line Absorption area(s)
Total effective absorption area
Nearest lot line
Distance to lot line
OTHER
SOl L TEST RATI ~
INSTALLER
REMARKS
APPROVED
DATE LEGAL
72-013 (Rev. 3/78)
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O~E
Russell Ol/,eter
694-2774
Soils ~ Foundations
Perfo~ed for:
GI:C. ,:CHNICAL Er DEVELuPMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 6~-2280
Ear/Ellis
688-2280
Land Development
Hetltng Address: ....
Tel. No.
Ground Water Encountered:
Proposed Ins talletton:
Comments',
Performed by:.
Yes_.._._No._____ If yes, whet depth._~
Seepage Pit_.___Drain Field.~.___
Date: ..............